1. (a) An individual who has capacity may execute a psychiatric advance directive.

2. (b) The psychiatric advance directive must include the following:

   1. (1) The name of the individual entering into the psychiatric advance directive.
   2. (2) The name of the treatment program and the sponsoring facility or institution in which the individual is enrolled, if applicable.

   3. (3) The name, address, and telephone number of:

      1. (A) the individual's treating physician; or
      2. (B) other treating mental health personnel.
   4. (4) The signature of the individual entering into the psychiatric advance directive.
   5. (5) The date on which the individual signed the psychiatric advance directive.
   6. (6) The name, address, and telephone number of the designated health care representative.

   7. (7) The signature of the psychiatrist treating the individual entering into the psychiatric advance directive, attesting to:

      1. (A) the appropriateness of the individual's preferences stated in the psychiatric advance directive; and
      2. (B) the capacity of the individual entering into the psychiatric advance directive.
3. (c) The psychiatric advance directive must comply with and is subject to the requirements and provisions of IC 16-36-1 .

As added by P.L.16-2004, SEC.3.